Free T4 levels going up then down. Advice for Endo appointment tomorrow please.

[Feelingrubbish]

Please could some look at my latest results of 4-1-23 and advise whether I should be asking for an increase in Levo when I see my endocrinologist tomorrow?

I am particularly puzzled about my Free T4 as it improved after increasing Levo from 25mcg to 50mcg in July and then further to 75mcg in September but at my latest test it has gone low again. My TSH is suppressed since upping my dose.

TSH 0.16 (0.35 - 4.94)... was <0.01 on 1-11-22... was 0.62 on 30-8-22... was 1.94 on 26-7-22

Free T4 11.8 (9.0 - 19.1) 27.72% through range... was 16.5 (9.0 - 19.1) 74.26% through range on 1-11-22... was 16.1 (12.3 - 20.2) 48.1% through range on 30-8-22... was 14.3 (12.3 - 20.2) 25.32% through range on 26-7-22

I was feeling much better at the end of last year. Then I caught a virus and was ill for about 3 weeks before Christmas. Could this affect my Free T4?

Thank you in advance

[SlowDragon Administrator]

Essential to test vitamin levels too

What vitamin supplements are you currently taking

75mcg is only one step up from starter dose levothyroxine

Have you had thyroid antibodies tested yet for autoimmune thyroid disease also called Hashimoto’s

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

thyroiduk.org/getting-a-dia...

[Feelingrubbish in reply to SlowDragon]

Thank for the speedy reponse.

I'm sorry, I didn't put all my info in my post. I have Hashimotos and have been taking supplements (Thorne Basic B Complex, Methyl B12, Gentle iron + Vit C, Vit D + Vit K, Magnesium) since August.

My results on 4-1-23 are showing some improvement in some areas:

Vitamin B12 726 (200 - 900)... was 358 on 30-8-22

Ferritin 50 (30 - 250)... was 26 (13 -150)

Folate 14.4 (3 - 20.5)... was 8.4 (>3.8)

Iron level 18 (9 - 30)... was 15 (5.8 - 34.2)

Transferring saturation index 25% (15 - 50) was TIBC 66 (45 - 70) are these the same thing?

Vitamin D 72 (50 - 200) was 73

[SlowDragon Administrator in reply to Feelingrubbish]

so vitamin D needs improving

How much vitamin D are you currently taking

Suggest you increase the dose of vitamin D

B12 now over 500

You can reduce and eventually stop separate B12. Probably should be fine on just daily vitamin B complex

Ferritin is improving slowly

Are you on strictly gluten free diet, dairy free diet?

[Feelingrubbish in reply to SlowDragon]

Vitamin D - I'm using Better You D3000+K2 - 3 sprays which I think is 75ug (3000 IU)

B12 - thank you, I will reduce this.

Diet - I'm not gluten free yet. I know that this is something to try but I wanted to take everything in steps to try and see how to improve my hair loss.

[SeasideSusie Remembering in reply to Feelingrubbish]

Feelingrubbish

Transferring saturation index 25% (15 - 50) was TIBC 66 (45 - 70) are these the same thing?

No they're not the same thing.

Total iron-binding capacity (TIBC): This test tells how much transferrin (a protein) is free to carry iron through your blood. If your TIBC level is high, it means more transferrin is free because you have low iron. Low in range indicates lack of capacity for additional iron, high in range indicates body's need for supplemental iron. Yours is quite high in range at 84% through range [66 (45 - 70)].

Transferrin saturation: This test measures the percentage of transferrin that is attached to iron. Optimal level is said to be 35-45% (higher end for males).

Hopefully both these levels will improve, along with serum iron and ferritin, with continued iron supplementation, but do monitor levels regularly.

[Feelingrubbish in reply to SeasideSusie]

Thanks for clearing that up - I was a bit confused as my iron test results seem to be testing different things.

[SlowDragon Administrator]

Difficult to read the thyroid results

Are these the Latest results

TSH 0.16

Ft4 11.8 (9-19.1)

Obviously in ideal world you would test TSH, Ft4 and Ft3 together

But it’s clear to see you need next 25mcg dose increase in levothyroxine up to 100mcg

Bloods should be retested 2-3 months after next dose increase

Which brand of levothyroxine are you currently taking

Do you always get same brand

Approx how much do you weigh in kilo

Guidelines on dose levothyroxine by weight is approx 1.6mcg levothyroxine per kilo of your weight per day

[Feelingrubbish in reply to SlowDragon]

Yes, those are the most recent results that the Endo will be looking at.

I'm on Teva and have been pretty much since I started taking Levo 3 years ago

I weigh about 72kg

[SlowDragon Administrator in reply to Feelingrubbish]

So Teva maybe an issue

Are you lactose intolerant?

don’t change two things at once

Get dose levothyroxine increase to 100mcg

Once settled on that you could then try different brand

Guidelines on dose levothyroxine by weight suggests eventual dose might be 115mcg per day

[Feelingrubbish in reply to SlowDragon]

Thank you for all the advice. I'm pretty sure I'm fine with lactose but it's something to try out later.